Occurs in response to the inability of the liver to convert ammonia to urea for excretion. the continued rise in ammonia leads to coma and eventual death.
**Give lactulose or Neomycin as the antidote

Alcohol myopathy

Result from Vitamin B deficiency that contributes to peripheral neuropathy.
Acut: Sudden onset of muscle pain, swelling and weakness
a. Reddish tinge to the urine and a rapid rise in muscle enzymes in the blood. Similar to MI
Chronic: Gradual wasting and weakness in skeletal muscles
a. Pain is no longer felt due to nerve damage.

Wernicke's encaphalopathy

Most serious form of thiamin deficiency in alcoholic pt's.
SSX: Paralysis of ocular muscles, diplopia, ataxia, somnolence and stupor

Korsakoff's psychosis

Syndrome of confusion, loss of recent memory, and confabulation in alcoholic pt's. Wernicke's-Korsakoff occur together

Phase I: Pre-alcoholic phase

Characterized by use of alcohol to relieve everyday stress and tension of life.
Tolerance develops at this stage and the amount required to achieve desired effects are increased

1. Person has lost control, physiological dependence is evident
2. The choice to drink isn't there
3. Person has physiolgical withdrawals

Phase IV: The Chronic Phase

1. Characterized by emotional and physical disintegration
2. Person is usually intoxicated more often than sober
3. Risk for suicide and pity

Withdrawal of sedative, hypnotic, or anxiolytic drugs

1. Tongue Fasiculations= tell pt to stick tongue and if the tongue has tremors (can't be faked) having withdrawal
2. Grandmal seizures- DT's

Patterns of Use/Abuse with CNS Stimulants

1. Individual begins to use for appetite-suppressant
2. People who use it on an episodic basis often "binge" on the drug with very high dosage and followed by a day or two with intense and unpleasant symtpoms (CRASH)
3. Chronic users: Take uppers in the AM and downers in PM